Active NPI
Jacob Kirby, DDS
- Dentist
- Tyler, TX
National Provider Identifier
1326303272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28111
- Practice address
- 5804 New Copeland Rd
Tyler, TX 75703-6217 - Phone
- (903) 561-1610
- NPI assigned
- Jul 6, 2012
- Last updated
- Jul 6, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 28111 | TX | Primary |
Addresses
Primary practice location
5804 New Copeland Rd
Tyler, TX 75703-6217
Mailing address
5804 New Copeland Rd
Tyler, TX 75703-6217
Phone (903) 561-1610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28111 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341532800000",
"number": "1326303272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5804 NEW COPELAND RD",
"city": "TYLER",
"state": "TX",
"postal_code": "757036217",
"telephone_number": "903-561-1610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5804 NEW COPELAND RD",
"city": "TYLER",
"state": "TX",
"postal_code": "757036217",
"telephone_number": "903-561-1610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "JACOB",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-06",
"last_updated": "2012-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "28111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.